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Related Experiment Videos

Replacing abdominally implanted defibrillators: effect of procedure setting on cost.

V R Vorperian1, S Lawrence, K Chlebowski

  • 1Department of Medicine, University of Wisconsin School of Medicine, Madison, USA. vrv@medicine.wisc.edu

Pacing and Clinical Electrophysiology : PACE
|June 3, 1999
PubMed
Summary

Replacing abdominally implanted cardioverter-defibrillators (ICDs) in the EP laboratory is significantly less expensive and leads to shorter recovery than in the OR. This study found no difference in complication rates between the two settings for ICD replacement.

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Area of Science:

  • Cardiology
  • Medical Device Technology
  • Health Economics

Background:

  • Most implantable cardioverter-defibrillators (ICDs) are placed pectorally, but a significant patient population has abdominal ICDs requiring generator replacement.
  • Battery depletion necessitates device replacement for patients with abdominally implanted ICDs.

Purpose of the Study:

  • To compare the cost, convalescence, and complication rates of replacing abdominally implanted ICDs in an operating room (OR) versus an electrophysiology (EP) laboratory.

Main Methods:

  • Prospective study of nine consecutive patients undergoing their second ICD generator replacement.
  • Comparison of procedures performed in the OR versus the EP laboratory, including cost analysis and complication assessment.
  • Procedures involved explanting the old device, lead system interrogation, defibrillation threshold confirmation, and new device implantation under local anesthesia and sedation.

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Main Results:

  • EP laboratory replacement resulted in significant reductions in physician fees ($2,179 vs $3,621), hospital charges ($2,306 vs $5,811), and total charges ($4,541 vs $9,431), excluding device cost (P < 0.05).
  • Average inpatient days were 3.0 in the OR compared to outpatient discharge within 4 hours in the EP laboratory.
  • No complications were observed in either setting during long-term follow-up (mean 39-42 months).

Conclusions:

  • ICD generator replacement in the EP laboratory is a cost-effective alternative to the OR.
  • EP laboratory procedures offer reduced healthcare charges and shorter patient convalescence without compromising safety.
  • This approach provides a viable option for managing abdominally implanted ICD replacements.